Shah Mahek, Jorde Ulrich P
Department of Cardiology, Montefiore Medical Center, Bronx, NY, United States.
Front Cardiovasc Med. 2019 Jul 12;6:88. doi: 10.3389/fcvm.2019.00088. eCollection 2019.
Mitral valve regurgitation (MR) is the commonest valvular abnormality encountered among adult patients with cardiac valvular disease and conveys significant morbidity and mortality. The mitral valve is a complex anatomical structure and etiology for regurgitation is classified as either or MR. Identification of the etiology in severe MR is critical in determining the appropriate treatment strategy. Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for treatment of selected patients with symptomatic chronic moderate-severe or severe (3 to 4+) MR. While surgery remains the mainstay for treatment in MR, several technological advances within the last decade have made transcatheter mitral valve intervention increasingly feasible and safe in clinical practice. Use of TMVR in patients with severe MR has successfully reduced patient symptoms, disease morbidity, improved quality of life, and facilitated reverse remodeling with potential for a survival advantage among certain patients with MR. Recent randomized controlled trials on MitraClip use in MR have reinvigorated interest in this disease and refocused our attention on optimizing patient selection and timing of intervention to maximize benefit from using such percutaneous devices. In our review, we discuss etiologies and pathophysiology in both acute MR and development of chronic severe MR. We discuss management strategies for MR among patients based on etiology, particularly percutaneous mitral valve interventional therapies. We perform an extensive review comparing and contrasting existing data on safety, efficacy, durability, and appropriate patient selection related to MitraClip implantation in both and MR. Lastly, we explore percutaneous MV therapies beyond the MitraClip as we await larger scale trials on these devices prior to them making way into day-to-day practice.
二尖瓣反流（MR）是成年心脏瓣膜病患者中最常见的瓣膜异常，具有显著的发病率和死亡率。二尖瓣是一个复杂的解剖结构，反流的病因分为原发性或继发性MR。在严重MR中确定病因对于确定合适的治疗策略至关重要。经导管二尖瓣修复术（TMVR）是一种微创技术，用于治疗有症状的慢性中重度或重度（3至4+）MR的特定患者。虽然手术仍然是原发性MR治疗的主要方法，但过去十年中的多项技术进步使经导管二尖瓣介入治疗在临床实践中越来越可行和安全。在严重MR患者中使用TMVR已成功减轻了患者症状、降低了疾病发病率、提高了生活质量，并促进了逆向重塑，对某些原发性MR患者可能具有生存优势。最近关于在继发性MR中使用MitraClip的随机对照试验重新激发了人们对这种疾病的兴趣，并将我们的注意力重新集中在优化患者选择和干预时机上，以最大限度地从使用此类经皮装置中获益。在我们的综述中，我们讨论了急性MR和慢性严重MR发展中的病因及病理生理学。我们根据病因讨论了MR患者的管理策略，特别是经皮二尖瓣介入治疗。我们进行了广泛的综述，比较和对比了与在原发性和继发性MR中植入MitraClip相关的安全性、有效性、耐久性和合适患者选择的现有数据。最后，在这些装置进入日常临床实践之前，我们期待着更大规模的试验，在此期间，我们探索了除MitraClip之外的经皮二尖瓣治疗方法。
